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Adebayo CT, Olukotun OV, Olukotun M, Kirungi J, Gondwe KW, Crooks NK, Singer RB, Adams S, Alfaifi FY, Dressel A, Fahmy L, Kako P, Snethen J, Valhmu LM. Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach. CULTURE, HEALTH & SEXUALITY 2024; 26:654-670. [PMID: 37516928 PMCID: PMC10825063 DOI: 10.1080/13691058.2023.2236163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.
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Affiliation(s)
| | | | - Mary Olukotun
- Faculty of Nursing, University of Alberta-Edmonton, Edmonton, AB, Canada
| | - Jackline Kirungi
- Department of African & African Diaspora Studies, University of Wisconsin, Milwaukee, WI, USA
| | | | - Natasha K. Crooks
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Randi B. Singer
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Shukri Adams
- Ras Al Khaimah School of Nursing, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Anne Dressel
- College of Nursing, University of Wisconsin, Milwaukee, WI, USA
| | - Laila Fahmy
- Department of Psychology, Towson University, Towson, MD, USA
| | - Peninah Kako
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
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Flaathen EME, Lukasse M, Cvancarova Småstuen M, Garnweidner-Holme L, Henriksen L. Intimate partner violence and the association of pregnancy intendedness - A cross-sectional study in southeastern Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100651. [PMID: 34364196 DOI: 10.1016/j.srhc.2021.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Unintended pregnancy in the context of intimate partner violence (IPV) is a public health issue. It is associated with increased health risks for women and their children. Our objective was to investigate the association between unintended pregnancy and emotional, physical and sexual IPV in a multi-cultural population attending routine antenatal care. STUDY DESIGN A prospective cross-sectional study of 1788 pregnant women who filled out a questionnaire during pregnancy as part of a randomized controlled trial conducted in southeastern Norway. MAIN OUTCOME MEASURES Pregnancy intendedness was measured by asking women if their pregnancy was planned or not. The Abuse Assessment Screen and the Composite Abuse Scale R-SF, consisting of descriptive questions, were used to measure IPV. Chi-square tests, a Mann-Whitney U test, and binary logistic regression analysis were used. RESULTS Almost one in five women (17.4%) reported that their current pregnancy was unintended. Women with unintended pregnancy were significantly younger, had lower educational backgrounds, more limited economic resources and were more likely to be non-native Norwegian speakers. A total of 15.3% of the women reported some experience of IPV in their lifetime. These women were significantly more likely to experience an unintended pregnancy than women who had not experienced IPV, after adjusting for confounding factors: AOR = 1.74 (95% CI [1.23-2.47]). CONCLUSIONS Women who had experienced IPV were significantly more likely to have an unintended pregnancy than women who had not experienced IPV. It is of major importance to identify those women and offer appropriate services during pregnancy.
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Affiliation(s)
- Eva Marie Engebakken Flaathen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway; Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway.
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Lisa Garnweidner-Holme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway; Division of General Gynaecology and Obstetrics, Oslo University Hospital, P.O Box 4950 Nydalen, N-0424 Oslo, Norway.
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Walter B, Indreboe H, Lukasse M, Henriksen L, Garnweidner-Holme L. Pregnant Women's Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study. JMIR Form Res 2021; 5:e28680. [PMID: 34283023 PMCID: PMC8335599 DOI: 10.2196/28680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/13/2021] [Accepted: 05/29/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. OBJECTIVE The aim of this study was to explore pregnant women's attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. METHODS Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. RESULTS Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women's attitudes toward and experiences with the tablet intervention. CONCLUSIONS Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. TRIAL REGISTRATION ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277.
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Affiliation(s)
- Bente Walter
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hege Indreboe
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Vestfold, Norway
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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SHARMA E, HOWARD N, DUCLOS D. Navigating new lives: A scoping review and thematic synthesis of forced migrant women's perinatal experiences. J Migr Health 2020; 1-2:100014. [PMID: 34405168 PMCID: PMC8352206 DOI: 10.1016/j.jmh.2020.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND For health systems and maternity services to respond effectively to forced displacement, an understanding of the lived experiences of women seeking protection during childbearing is required. This study aim was to systematically review existing literature on the perinatal experiences of forced migrant women. METHODS We conducted a scoping review including MEDLINE, CINAHL Plus, Web of Science and PsychINFO databases and manual search of references. Included studies were quality-assessed and analysed using inductive thematic synthesis. FINDINGS In total 39 studies were included, involving 624 forced migrant women in 12 countries. Three inductive themes were: (1) "The nature of being a forced migrant," describing multiple liminalities experienced by women; (2) support during the perinatal period, showing women's (re)negotiation of shifting kinship and support networks; and (3) interactions with maternity services, revealing variations in maternity care experiences. CONCLUSION Findings highlight the systemic power structures forced migrant women must (re)negotiate during the perinatal period and the supportive and empowering role maternity services can play through provision of woman-centred care. Further research is needed to understand the lived perinatal experiences of forced migrant in low-income and transit country contexts.
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Affiliation(s)
- Esther SHARMA
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Natasha HOWARD
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- National University of Singapore, Saw Swee Hock School of Public Health, 12 Science Drive 2, 117549, Singapore
| | - Diane DUCLOS
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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Flaathen EME, Lukasse M, Garnweidner-Holme L, Angelshaug J, Henriksen L. User-Involvement in the Development of a Culturally Sensitive Intervention in the Safe Pregnancy Study to Prevent Intimate Partner Violence. Violence Against Women 2020; 27:2235-2354. [PMID: 32985376 PMCID: PMC8404717 DOI: 10.1177/1077801220954274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intimate partner violence (IPV) during pregnancy has negative health impacts on the woman and the fetus. There is a lack of evidence supporting effective interventions to prevent IPV during pregnancy. This user-involvement study was conducted to get feedback on a culturally sensitive, tablet intervention containing questions about violence and safety-behaviors and a video promoting safety behaviors. This resulted in important feedback on the intervention content. Our findings show that women are in favor of disclosing IPV via a tablet. They suggested ways to address barriers for disclosure, such as safeguarding anonymity and creating a trustful relationship with the midwife.
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Jannesari S, Hatch S, Oram S. Seeking sanctuary: rethinking asylum and mental health. Epidemiol Psychiatr Sci 2020; 29:e154. [PMID: 32787983 PMCID: PMC7443819 DOI: 10.1017/s2045796020000669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022] Open
Abstract
Forced migrants are at an increased risk of mental disorder compared to host country populations. To effectively address this, programmatic and policy responses need to be underpinned by rigorous evidence. Drawing on our experience conducting a systematic review of post-migration risk factors for mental disorder among asylum seekers and our appraisal of related systematic reviews, this paper discusses four challenges facing the field: (1)The reliance on Western conceptions of mental health.(2)The investigation, to date, of a relatively narrow range of potential risk factors.(3)The lack of consistency in the measurement and reporting of risk factor variables.(4)The use of the legal term 'asylum seeker' to define study populations.We suggest potential ways forward, including using mental health measures developed in collaboration with communities affected by forced migration, the examination of key risk factors around homelessness and workers' rights, the development of a core set of risk factors to be investigated in each study, and defining study populations using the conceptual category of 'sanctuary seekers' - people who have fled their country and are asking another country for safety and residence.
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Affiliation(s)
- Sohail Jannesari
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephani Hatch
- Psychological Medicine, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Siân Oram
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Fair F, Raben L, Watson H, Vivilaki V, van den Muijsenbergh M, Soltani H. Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review. PLoS One 2020; 15:e0228378. [PMID: 32045416 PMCID: PMC7012401 DOI: 10.1371/journal.pone.0228378] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. OBJECTIVE To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country. SEARCH STRATEGY CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. SELECTION CRITERIA Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. DATA COLLECTION AND ANALYSIS Qualitative data were extracted and analysed using thematic synthesis. RESULTS The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way-the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'. CONCLUSIONS Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.
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Affiliation(s)
- Frankie Fair
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Liselotte Raben
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Helen Watson
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Victoria Vivilaki
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Hora Soltani
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
- * E-mail:
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Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Humanitarian migrant women's experiences of maternity care in Nordic countries: A systematic integrative review of qualitative research. Midwifery 2019; 80:102572. [PMID: 31739182 DOI: 10.1016/j.midw.2019.102572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maternal morbidity and sub-optimal maternity care are more common in humanitarian migrants in comparison to country-born population in the Nordic countries. Statistical reviews on the issue are plenty, whereas little synthesis on humanitarian migrants' lived experiences exists. AIM This systematic integrative literature review investigated humanitarian migrant women's experiences on maternity care in Nordic countries, aiming to address possible hindrances for optimal care. METHODS Electronic search in PubMed, CINAHL, SocIndex, Scopus, PsycINFO and Web of Science yielded 474 papers. PICoS inclusion and exclusion criteria were used. Critical appraisal was conducted utilising 32-item COREQ tool. The findings of the review articles were synthesised through thematic analysis. FINDINGS Ten qualitative studies were included in the review. Altogether 198 women in Sweden, Norway and Finland had participated interviews or focus group discussions. Analysis of the women's reported experiences of care emerged three themes: Diminished negotiation power on care, Sense of insecurity, and Experienced care-related discrimination. KEY CONCLUSION Humanitarian migrant women's maternal morbidity and sub-optimal care has multiple potential explanations, and their experiences of care reflect those earlier reported. IMPLICATIONS FOR PRACTICE Recommendations for tackling the addressed hindrances are: (1) enabling humanitarian migrant women's negotiation power by acknowledging their vulnerability but also competency, (2) increasing the sense of security, and (3) improving care providers' cultural competence.
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Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Kuopio University Hospital, Finland
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Byrskog U, Ahrne M, Small R, Andersson E, Essen B, Adan A, Ahmed FH, Tesser K, Lidén Y, Israelsson M, Åhman-Berndtsson A, Schytt E. Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project. BMJ Open 2019; 9:e030314. [PMID: 31371301 PMCID: PMC6677950 DOI: 10.1136/bmjopen-2019-030314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes. OVERALL AIM To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study. METHODS AND ANALYSIS An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group. ETHICS AND DISSEMINATION The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.
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Affiliation(s)
- Ulrika Byrskog
- School of Education, Health and Social sciences, Dalarna University, Falun, Sweden
| | - Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rhonda Small
- Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Birgitta Essen
- Womens and Childrens Health, Uppsala University, Uppsala, Sweden
| | - Aisha Adan
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Fardosa Hassen Ahmed
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Karin Tesser
- Antenatal Care Clinic, Domnarvet, Borlänge, Sweden
| | | | | | | | - Erica Schytt
- Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Abstract
BACKGROUND Privacy is one of the key principles in health care and requires understanding of the cultural aspects of patients' privacy. In Western cultures privacy is focused on the individual, however, in some non-Western cultures, privacy is linked to the collectivism of the community or religion. OBJECTIVES The objective of this study is to describe the factors related to the realisation of privacy of Somali refugees in health care by describing the factors related to the patient, healthcare professional and interpreter. RESEARCH DESIGN The data were collected from Somali refugees (N = 29) using a qualitative questionnaire and were analysed by deductive content analysis based on factors related to the patient, healthcare professional and interpreter. ETHICAL CONSIDERATION Ethical approval was obtained from the University of Turku, and research permissions were obtained from all participating institutions. FINDINGS Factors related to the patient were as follows: privacy was realised when the patient had self-determination; was able to act according to Somali culture; had knowledge and understanding of treatment; and trusted the healthcare professional. Factors related to the healthcare professional were as follows: the healthcare professional was expected to be of the same gender as the patient, act professionally, focus on the health issues, and to have knowledge and understanding of the Somali culture. Factors related to the interpreter were as follows: the presence and Somali background of the interpreter decreased privacy; the interpreter was expected to be of the same gender as the patient; to have competence and to behave professionally. DISCUSSION Gender congruence, professionalism and caring attitude and common understanding between the Somali patient and Finnish provider increase the privacy of Somali patients. CONCLUSION Somali patients' privacy can be improved by increasing healthcare professionals' understanding of Somali culture, acknowledging the importance of gender concordance in relation to healthcare professionals and interpreters, and the effect of the presence of the interpreter on patients' privacy.
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Affiliation(s)
- Niina Eklöf
- South-Eastern Finland University of Applied Sciences, Finland; University of Turku, Finland
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Ahrne M, Schytt E, Andersson E, Small R, Adan A, Essén B, Byrskog U. Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives. Midwifery 2019; 74:107-115. [PMID: 30953966 DOI: 10.1016/j.midw.2019.03.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents. DESIGN Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks". SETTING Two towns in mid-Sweden and a suburb of the capital city of Sweden. PARTICIPANTS Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling. FINDINGS Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth. KEY CONCLUSIONS ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.
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Affiliation(s)
- Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden.
| | - Erica Schytt
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden.
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Aisha Adan
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden
| | - Birgitta Essén
- Women's and Children's Health, IMCH, Uppsala University, Sweden.
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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Garnweidner-Holme LM, Lukasse M, Solheim M, Henriksen L. Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women's advice for better communication in South-East Norway. BMC Pregnancy Childbirth 2017; 17:123. [PMID: 28420328 PMCID: PMC5395889 DOI: 10.1186/s12884-017-1308-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/12/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women constitutes a major public health problem. Antenatal care is considered a window of opportunity to disclose and to communicate about IPV. However, little is known about how women from different ethnic backgrounds wish to communicate about their experiences with IPV during pregnancy in antenatal care. The aim of the present study was to explore how women from different ethnic backgrounds experienced IPV and what their recommendations were about how midwives should communicate about IPV in antenatal care. METHODS Qualitative individual interviews with eight women who had experienced IPV during pregnancy were conducted and analysed using thematic analysis. The participants were purposively recruited from three crisis shelters in South-East Norway. RESULTS The participants either had immigrant backgrounds (n = 5) or were ethnic Norwegians (n = 3). All participants received antenatal care by a midwife. Although none of the participants were asked about IPV during antenatal care, they wished to talk about their experiences. Most participants felt that it would be important for the midwife to make them aware that they were victims of violence. Participants offered different suggestions on how and when midwives should talk about IPV. Facilitators to talk about IPV with the midwife were a good relationship with and the trustworthiness of the midwife, information about possible negative health outcomes for the newborn owing to IPV and knowing that the midwife could help them. The main barriers to talk about IPV with the midwife were that the participants were accompanied by their husbands during antenatal care, fear that the Child Welfare Service would take away their children after disclosure and cultural acceptance of violence. Participants with immigrant backgrounds also experienced difficulties in talking about IPV owing to their limited language skills. They thought that professionally trained interpreters with experience of IPV could overcome this barrier. CONCLUSION Even though none of the participants were asked about IPV in antenatal care, they offered different suggestions on how and when midwives should talk about IPV. Participants irrespective of their ethnical backgrounds perceived antenatal care as a key area to facilitate disclosure of IPV. Midwives' communication and strategic skills to address IPV are crucial for help-seeking women. Training midwives' skills in culture-sensitive communication might help to overcome cultural barriers to talk about violence.
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Affiliation(s)
- Lisa Maria Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, St. Olavs Plass, P.O. Box 4, 0310 Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, St. Olavs Plass, P.O. Box 4, 0310 Oslo, Norway
| | - Miriam Solheim
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, St. Olavs Plass, P.O. Box 4, 0310 Oslo, Norway
| | - Lena Henriksen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, St. Olavs Plass, P.O. Box 4, 0310 Oslo, Norway
- Division of General Gynaecology and Obstetrics, Oslo University Hospital, Nydalen, P.O. Box 4950, Oslo, 0424 Norway
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